The experience of double-filtration plasmapheresis thermo-mode (DF thermo) for hemodialysis patients with severe ASO

Abstract

In recent years, many choices for arteriosclerosis obliterans (ASO) treatment have been reported. Double-filtration plasmapheresis thermo-mode called “DF thermo” is reported to be effective for ASO. To our knowledge however, only one severe ASO patient has been reported. We performed “DF thermo” treatment for two hemodialysis patients with severe ASO. Case 1 was a 76-year-old woman. Hemodialysis was indicated for end-stage renal disease due to diabetic nephropathy in November 2000. She demonstrated ulcer on the right first toe that had progressed from a shoe sore in January 2005. Because the ulcer was not improved by medical and interventional treatment, “DF thermo” was performed from September 2005 and the ulcer was improved thereafter. Case 2 was 71-year-old man. He had been treated for diabetes for 30 years at an other hospital. He was also being treated for poor color of the right foot from July 2005, but the color did not improve. Since diarrhea, loss of appetite and dehydration appeared and renal dysfunction subsequently worsened, he was hospitalized. After hospitalization, hemodialysis was indicated and “DF thermo” was initiated from October 2005. Because the ulcer was worsening and aggravation of the infection appeared after the fifth treatment, right knee amputation was performed by emergency surgery. Daily observation, care and various treatments may avoid the need for amputation. As for “DF thermo”, the potential for this method to become one of the treatments of choice is suggested. Herein we present two cases and discuss some consideration based on the literature.